Postoperative care of the critically ill endocarditis patient

Patients with infective endocarditis who undergo surgery face many postoperative challenges both general to cardiac surgery and specific to endocarditis. The combination of vasoplegia, sepsis, and cardiogenic shock is frequently present and demands active hemodynamic monitoring and targeted fluid management. Preoperative risk factors including arrhythmias, embolic stroke, and active infection increase the risk of postoperative complications. Postoperative management of anticoagulation, antimicrobial therapy, arrhythmias, and pain management are essential for reducing morbidity and mortality in this patient population that had recently undergone major operative stress in the setting of active infection. And when complications do occur, including stroke, renal, and respiratory failure, prompt recognition and management can prevent further adverse outcomes in this critically ill population. This chapter discusses the considerations, recommendations, and management of endocarditis patients following surgery, and the postoperative conditions and complications that threaten their successful recovery.